LASER SAFETY. The use of lasers in the medical field is increasing at a tremendous rate.
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1 LASER SAFETY The use of lasers in the medical field is increasing at a tremendous rate. As laser treatment increases the potential for laser accidents also increases.
2 LASER SAFETY The Joint Commission EC The hospital minimizes risks associated with selecting and using hazardous energy sources. This includes ionizing (radiation and x- ray equipment) and non-ionizing equipment (LASER s and MRI s) Possible TRACER during survey.
3 LASERS IN MEDICINE - Surgery (photothermal energy) - Lithotripsy (photoacoustical energy) - Tattoo Removal (photothermal energy) - Hair Removal (photothermal energy) - Photodynamic therapy (photochemical energy)
4 UNDERSTANDING LASER SAFETY To understand laser safety the following questions need to be answered: What is a laser? What are the potential hazards? How can these hazards be prevented?
5 WHAT IS A LASER? L ight A mplification by S timulated E mission of R adiation
6 LASER BASICS Laser light differs from ordinary light in 3 ways: 1. Monochromatic - light that is one color or a single wavelength. 2. Directional - traveling in one direction from point of origin. 3. Coherent - orderliness of wave patterns by being in phase in time and space These three properties allow a laser to focus a lot of energy onto a small area.
7 LASER BASICS There are three absorbers of light in tissue Water, Hemoglobin, Melanin Water Absorption (i.e. CO2 LASER used for soft tissue; cells expand when heating occurs) Water Transmission (i.e. Diode LASER, KTP Green Light LASER) Knowing the absorption/transmission is important in determining the hazards and hazard controls.
8 BEAM RELATED HAZARDS Hazardous effects related to unintentional direct contact with the laser beam -Eye related -Interaction hazards (Plume and Fire) -Skin related
9 EYE RELATED HAZARDS Corneal/Sclera Injury: caused by wavelengths that do not pass through fluid (roughly above 1400 nm and below 400 nm) Retinal Burns Injury: caused by wavelengths that do pass through fluid from (roughly nm)
10 Corneal injury from CO2 laser Retinal injury from a dye laser
11 intensity - lens of eye can focus beam onto the retina wavelength - absorbed by different parts of the eye duration - fraction of second, before you can blink EYE RELATED HAZARDS Injury can result from exposure to: direct beam mirror reflection (surgical instruments) diffuse beam (tissue reflection) Damage dependent on:
12 Direct Beam Reflected Beam Diffuse Beam
13 INTERACTION HAZARDS Plume - Plume - smoke from vaporization - Creates a visibility problem - Can cause nausea - Potential health hazard
14 INTERACTION HAZARDS What is the plume? - Carbon - Aerosolized blood - Bacteria Plume - Viral particulates -Gases including benzene, toluene and formaldehyde
15 INTERACTION HAZARDS Plume plume particle size microns standard surgical mask particle filtration efficiency: - 5 microns - 99% micron - 25% - double mask - 30% Do not rely on the surgical mask for filtration. The use of a smoke evacuator is the preferred control method.
16 FIRE AND EXPLOSION Can occur if the laser beam comes into contact with combustible or volatile materials, such as: - gauge pads - surgical drapes - gowns - alcohol - anesthetic gases - plastic trach tubes - rectal gases
17 SKIN RELATED - Thermal burn - Laser effects on tissue are dependent on 4 factors: - power density of laser beam - wavelength - duration of exposure - effects of circulation and conduction
18 NON-BEAM RELATED HAZARDS Hazards associated with the generation of the laser beam Electrical High voltage many lasers require high voltage to generate the laser beam. Accidental exposure can result in electrical shock or death Chemical Dye lasers use hazardous dyes to generate the laser beam (hazardous waste)
19 CONTROL MEASURES There are 3 basic control measures: - Engineering - Administrative - Personal protection
20 ENGINEERING These are control measures that are built into the laser system, such as: - enclosing the electrical system, within a cabinet - enclosing the beam within fiber optics or mechanical arms
21 ADMINISTRATIVE CONTROLS - Controlled entry - Education - Standards
22 CONTROLLED ENTRY Closing doors and covering windows (when required) Posting of the PROPER Laser in Use signs outside all entries.
23 EDUCATION All personnel that may be exposed to the laser shall be required to attend regular in-services on operating the laser and laser safety.
24 STANDARDS Each medical facility should develop their own set of operating standards. American National Standards For The Safe Use Of Lasers American National Standards For The Safe Use Of Lasers In The Health Care Facility
25 Institutional Procedures & Policies Laser Systems (HM ) UT Laser Safety Manual (HM Appendix A) Operating Room LASER Operation, Safety and Procedures ( through ). Policies are in the process of being combined.
26 OR Policies LASER team members will attend yearly LASER safety in-services. LASER questions have been added to the safety test bank. Qualified LASER team members will function independently of the circulating nurse.
27 OR Policies LASER Staff Member will: Post LASER signs Provide PPE for patient and staff and monitor use during the procedure. Calibrate and test fire the LASER pre-operatively when required. Monitor policies/procedures. Complete the LASER Checklist. Report any incidents to the OR Nurse and UT LSO.
28 Eye Protection OR Policies Ensure the patients eyes are protected (see policy). All personnel in the room must wear eye protection. Endoscopic lens covers with special filters can be used during microscope procedures to provide protection. LASER safety glasses must be made available on the door of the room. COVER windows when required.
29 OR Policies LASER Generated Air Contaminants (LGAC s) LASER must not be activated until the smoke evacuator is positioned near the tissue interaction site and is operating.
30 Foot Pedal OR Policies Must be operated by the surgeon. Will not be placed near any liquids to minimize electrical hazards. Must be inspected for fraying or breaks in the cords. Must be identified verbally by the LASER team member when placing it for use. Other foot pedals will also be verbally identified to avoid confusion.
31 Fire Safety OR Policies Use wet draping around the intended LASER site to reduce possible ignition. A basin of 1000ml of saline must be readily available. During a LASER procedure on the lower bowel, the rectum must be packed with a wet radiopaque sponge
32 Fire Safety OR Policies SPECIAL precautions must be taken during trachea procedures to reduce the potential for ET tube fires (special tube and no-explosive gases). Use of non-reflective instruments. NO flammable prep solutions
33 LASER Operation OR Policies Keys must be removed when not in use. LASER will remain off when not in use. Surgeon is responsible for setting the LASER settings. Only the surgeon or resident under supervision of the surgeon will operate the LASER power activation controls. The LASER will be placed in Standby mode on verbal command when the surgeon removes his hands or eyes from the field or LASER equipment.
34 OR Policies LASER Instrumentation Ensure proper instrumentation for the procedure to reduce the potential for melting, reflection, fire, plume. Instruments can be covered with wet towels or sponges to decrease the chance of LASER reflection. Stainless steel mirrors used to reflect the LASER beam must be inspected regularly.
35 Procedure #HM Laser Systems All Departments/Divisions must have policies & procedures addressing safety precautions for personnel Medical staff shall be credentialed (written record)
36 PERSONAL PROTECTION - Eyewear - Barriers - Fire protection - Smoke evacuation & filtration
37 EYE PROTECTION Eyewear - Each laser requires specific eyewear that is capable of absorbing laser light of that specific wavelength
38 EYE PROTECTION Everyone in the laser OR must wear eye protection including the patient
39 EYE PROTECTION -Patient the patient s eye s can be protected by: - covering with moist towels - goggles - intra-ocular shields
40 EYE PROTECTION -The surgeon must have eye protection, even during microscopic and endoscopic procedures. -Lens filters that fit over the eyepiece can be used
41 SKIN PROTECTION Barriers - Clothing - Gloves - Fire resistant gowns - Fire resistant surgical drapes - Moist gauze and drapes around surgical area
42 SKIN PROTECTION Clothing Offers some protection from skin exposure to laser beams, unfortunately most OR s use flammable gowns and drapes thus increasing the potential for fire hazards - all gauze and drapes around the surgical area should be moistened with sterile saline.
43 SMOKE EVACUATION & FILTRATION Commercially available smoke evacuators filter out the smallest particles (0.1 µ) found in the laser plume - to be completely effective the smoke evacuator suction tube must be placed as near to the site of laser ablation as possible (less than 2 cm)
44 SMOKE EVACUATION & FILTRATION Filtration -HEPA (high efficiency particulate air) Filter % efficient at filtering 0.3 micron particles -Bacterial filter -ULPA (ultra-low penetration) Filter % efficient at filtering 0.12 micron particles -Viral filter
45 LASER BASICS UTMC LASERS 10,600 nm (IRC) Hazards Eye Hazards (Corneal) Skin Hazards (Skin Burns) Electrical Hazards Fire Hazards LGAC s (LASER Generated Air Contaminants) Controls LASER Safety Glasses Smoke Evacuator Policy/Procedures Nominal Hazard Zone: Entire Room CO2 LASER
46 LASER BASICS -TYPES of LASERS 2,100 nm (IRB) Hazards Eye Hazards (Corneal) Skin Hazards (Skin Burns) Electrical Hazards Fire Hazards Controls LASER Safety Glasses Policy/Procedures Nominal Hazard Zone: Entire Room Holmium:YAG LASER Cardiology (TMR) Urology
47 LASER BASICS -TYPES of LASERS 980 nm (IRA) Hazards Eye Hazards (Cataract and Retinal Burn) Skin Hazards (Skin Burn) Electrical Hazards Fire Hazards Controls LASER Safety Glasses Window Covers Policy/Procedures Nominal Hazard Zone: Entire Room Diode LASER (Precision 980)
48 LASER BASICS -TYPES of LASERS 308nm (UVB) Hazards Eye Hazards (Simultaneous Cornea, Lens, Retina effects observed) Skin Hazards (Increased Pigmentation) Electrical Hazards Fire Hazards Controls LASER Safety Glasses Policy/Procedures Nominal Hazard Zone: Entire Room XeCl LASER
49 LASER BASICS -TYPES of LASERS 532 nm (UVB) Hazards Eye Hazards (Retinal Burn) Skin Hazards Electrical Hazards Fire Hazards Plume (Minimal) Controls LASER Safety Glasses Policy/Procedures Nominal Hazard Zone: Entire Room Window Covers (Currently used in a room without windows). KTP Green Light LASER
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